Archive for the ‘Stress Relief’ Category

Prescription opiate medication for chronic pain is a treatment whose time is ending. To quote Dr. Tom Frieden, director of the Center for Disease Control (CDC), for most pain patients the benefits of opiate painkillers are “unproven and transient” and they can be “just as addictive as heroin.” In addition, annually since 1999, ten thousand people have died from overdoses of prescription painkillers. The pain management community has concluded that, apart from people with cancer pain or those at the end of life, opiate painkillers have become a public health crisis. The CDC now recommends against using them for most non-cancer patients.

Acceptance by the health care profession that Psychophysiologic Disorders (PPD) can be successfully diagnosed and treated will depend on completion of at least two randomized controlled trials (RCT). The RCT is the gold standard method for documenting that a new form of treatment is superior to a placebo. Only when a treatment passes this test and that passing is then confirmed by at least one additional RCT will clinicians consider making the effort to apply it to their patients.

Causes of psychophysiologic disorder (PPD) symptoms are so diverse that even after assessing thousands of patients I still encounter new variations. Earlier this year a 65 year old retired nurse practitioner from Oregon whom I have worked with in the past contacted me because of months of abdominal pain. She suspected PPD because medical evaluation was unrevealing and her symptoms fluctuated for no obvious reason.

Recent on-line and in-person discussions with my colleagues who care for patients with Psychophysiologic Disorders (PPD) make it clear that there are many successful approaches to diagnosis and treatment. What these techniques have in common is clarifying for patients that psychosocial stress can cause real pain and/or other physical symptoms and that uncovering and treating these issues can relieve the illness (partially or completely). Our discussion led me to summarize my approach: (more…)

A colleague and friend has written a deeply personal essay about his troubled relationship with his father. It led me to reflect on the 4000+ interviews I have done with people whose illnesses were linked to their childhood experience. Some learning from those patients:

The last post briefly described a few psychotherapy concepts employed by students of Carl Jung. I wrote this to suggest the diversity of the scores of theoretical models currently used to treat clients. Why are there so many? The answer seems to be that they are all about equally effective when compared in trials so none has become dominant. Why are they so similar in their outcomes? The best explanation is that the theory behind a particular psychotherapeutic approach is one of the least important of several factors that determine how much a client benefits from treatment. What are these other components? In order of importance they are factors connected to: (more…)

In the next edition of The Economist magazine is an article about Edzard Ernst, professor of complementary medicine at Peninsula College of Medicine in Exeter, in southwestern UK. He is retiring after 18 years of studying “alternative” medical remedies which includes acupuncture, chiropractic medicine, Reiki, herbal remedies, Ayurvedic medicine, homeopathy, reflexology and many others. During this time he and his group published over 160 analyses of the research in these fields.

After 4.5 hours of instruction, two dozen mental health clinicians (MHCs) with varied training and experience were able to find the diagnosis in a half-dozen simulated stress illness patients. So I also talked to them about reaching out to medical clinicians to teach them how to explain the following concepts to their patients: (more…)

After four and a half hours of instruction in how to do a Stress Check-Up (which is an Illness Chronology plus a Stress History), my next question was whether my audience of two dozen mental health professionals could use it to diagnose a “real patient.” So I tested them.